胃大部切除术后腹腔镜胆囊切除术临床探析.docVIP

胃大部切除术后腹腔镜胆囊切除术临床探析【摘要】 目的 探讨胃大部切除术后腹腔镜胆囊切除的可能性及手术方法与技巧。方法 48例胃大部切除术采用闭合法建立气腹,分离粘连,暴露胆囊全貌及Calot三角顺行或逆行切除胆囊。结果 48例中LC成功46例,中转开腹2例,全组无明显出血,胆道损伤和胆汁漏等并发症发生。结论 部分胃大部切除术后胆囊良性疾病LC术可行。 【关键词】胃大部切除手术;腹腔镜胆囊切除;粘连 Laparoscopic cholecystectomy after subtotal gastrectomy WANG Xiao-dong,JIANG Cui-cui,LI Chun-hai.The central hospital of Jiamusi Helongjiang,Jiamusi 154002,China 【Abstract】 Objective To investgate the practicability and technical skill of laparoscopic cholecystectomy(LC)for patients with a history of subtotal gastrectomy.Methods LC was performed in 48-patients with benign diseases of gallbladder after subtotal gastrectomy.Pneumoperitoneum was formed by closed-method.Under laparoscope,intraperitoneal adhesion was loosened;the anatomical position of gallbladder and Calot′s triangle were exposed clearly.Finanally,the cholecystectomy was conducted though routire LC.Results 46 cases were successful in 48 cases with Laparoscopic Cholecystectomy.There was no hemorrhage bile duct injure or cholorrhea and open cholecystectomy(OC)was done in another two because of mistaking cystis duct with adhesive band.Conclusion LC is to test considered first in the treatment of benign diseases of gallbladder such as cholecystolithiasis and cystic polyps after subtotal gastrectomy and the curative effects and the same as those of routine LC. 【Key words】Subtotal gastrectomy; Laparoscopic cholecystectomy; Intraperitoneal adhesion 作者单位:154002黑龙江省佳木斯市中心医院普外科 我院自2006年3月至2010年3月共对有胃大部切除术病史患者行LC术48例,并取得较好的疗效。现报道如下。 1 资料与方法 1.1 一般资料 本组共48例,既往有上腹部手术病史的患者男29例,女19例。年龄39~71岁,平均49.8岁。其中,慢性结石性胆囊炎30例,胆囊息肉18例。 1.2 手术方法 全部病例均在全麻下采用腹壁四孔法实施LC术,开放法建立气腹,置入10 mm Trocar进入腹腔镜头,探查腹腔内情况。第二穿刺孔的位置可选择剑突下原切口旁偏右或右锁骨下穿刺。穿刺成功后抓钳或超声刀分离粘连,显露Calot三角后,生物夹夹闭胆囊管和胆囊动脉,逆行切除胆囊。术后留置胶管引流,胆囊床处喷涂生物蛋白胶。 2 结果 48例采用闭合法穿刺建立气腹均获成功,本组手术术中探查均有不同程度的粘连。以原切口下方粘连最为明显。6例部分肠管与腹壁粘连,切除部分腹膜。根据术中观察,距离第一次手术时间越长,粘连越轻,反之粘连较重。本组病例中46例LC术取得成功。2例因Calot三角粘连致密,分离出血明显,术野无法分辨,中转开腹手术,手术时间45~140 min,平均67 min,较无上腹部手术病史的LC术,时间明显延